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Canadian Doctors for Refugee Care

What Happened

Health care and professional services organizations across Canada opposed to the cuts formed the group Canadian Doctors for Refugee Care in the spring of 2012. They were promptly branded by then-Citizenship and Immigration Minister Jason Kenney’s office as “activists” who have “purposefully altered” the facts when reporting on cases of patients needing care. Canadian Doctor for Refugee Care and the Canadian Association of Refugee Lawyers launched a legal challenge in February 2013 claiming the cuts were unconstitutional, a move which was met by further dismissing remarks from Minister Kenney, who qualified it as “part of an ongoing ideological campaign.”On July 4, 2014, the Federal Court of Canada rendered its decision on the challenge, striking down the cuts to the IFHP, finding that they constituted "cruel and unusual treatment," contrary to section 12 of the Canadian Charter of Rights and Freedoms.

Since 1957, Citizenship and Immigration Canada funded the Interim Federal Health Program (IFHP) to provide temporary health care coverage to refugees and people claiming refugee status.

Eligible protected persons, refugee claimants and rejected refugee claimants do not generally qualify for provincial or territorial health insurance plans.The IFHP provides health benefits which “bridges” refugees between the time of their arrival in Canada and the time they become elegible for provincial health coverage or until they are deported if their claim is rejected.

The cuts

Prior to June 30, 2012, all refugees and refugee claimants had access to health care in Canada (including hospital services) and to supplementary health benefits (dental and vision care), on a comparable basis to Canadians and/or to social assistance (welfare) recipients.

According to a Postmedia report, the cuts were buried in the 2012 federal March budget, and so no one realized it until the actual cuts were announced later on. There was no prior consultation with health care professionals, or with the provinces. According a Globe and Mail report, documents obtained through Access to Information requests, show that civil servants were frantically trying to preserve the program months before it was announced. It is estimated that the cuts will generate about $100 million of savings.

Changes to the regulations governing the IFHP mean that the federal government has drastically reduced or eliminated these health services for refugees and refugee claimants, effective July 1, 2012.

The pre-cuts cost of the program amounted to about $3 per Canadian per year.

Health care providers protest

On May 11, 2012, doctors across Canada publicly protested the changes. Many are physicians treat refugees themselves or work in clinics that have turned people away. Later that month, eight prominent health care groups wrote to Minister Jason Kenney to voice their opposition to the cuts.

The respected Wellesley Institute joined its voice to the growing chorus of opposition on May 28. A week before, the Toronto Board of Health issued a memorandum, on May 17, expressing concerns about the cuts.

On June 18, more than 2,000 health care workers came together for a National Day of Action to protect refugee health care services. On that same day, Amnesty International spoke out against the changes, noting that they violate international commitments with respect to the right to health care.

On June 28, the Canadian Civil Liberties Association wrote a letter to Minister Jason Kenney to express deep concerns regarding the cuts and announce their support to the National Day of Action.

On June 29, the federal government backtracked partially on the cuts, for example, Government-Assisted Refugees are no longer impacted by the cuts. Other groups, however, are still denied important health benefits unless their state of health consitutes a public emergency.

To further complicate matters, people have access to different levels of service, depending on where they live. For example, while Quebec continues to provide medical coverage for refused refugee claimants until deportation, comparable coverage does not exist elsewhere in Canada.

Harper government attacks doctors

Canadian Doctors for Refugee Care began documenting dozens of cases of patients denied treatment. The group issued its first interim report in September 2012, on the impact of the new changes on patients. “The IFH Program is in disarray and being mismanaged and the health of all refugees is being placed at risk,” said Dr. Philip Berger, Chief of Family and Community Medicine at St. Michael’s Hospital.

Alexis Pavlich, a spokesperson for Minister Jason Kenney, responded by suggesting that the doctors were either misleading the public or even lying; he is reported to have said: “The majority of the alleged cases are either factually incorrect or the real status of these individuals has been purposely altered,” adding that the medical doctors are “activists.” In fact, while the names of patients have obviously been withheld from the public for reasons of confidentiality, there was no reason to assert that the reports were inaccurate.

Reduced access to health care for vulnerable refugee claimants

The “baskets” of services are complex in terms of who is eligible for what, and when. Under the new IFHP, a maze of procedures, forms and technicalities has made the system difficult to understand and harder to access. The result, according to doctors, has been chaos, confusion and mismanagement, and the denial of medically-necessary treatments for people in need, including expectant mothers, young children and diabetics needing insulin.

Government-assisted refugees are still entitled to health care services, which are now termed “expanded.” But other refugees are not, and will be barred from making claims in their first year. Privately-sponsored refugees and refugee claimants, however, are no longer entitled to rehabilitation or long-term care, and cannot access free medication unless there is a threat to public health and/or safety. As noted in commentary initially published by the Montreal Gazette,

“a woman who arrives on July 1 from Syria or Eritrea (or choose any country with a similar human rights record), whose story of persecution is solid and who is extremely likely to be recognized as a refugee once she has her hearing, will be denied medication if she is, say, diabetic, or as cancer or heart disease.”

Refused claimants, and claimants arriving from designated countries of origin (democratic countries deemed to have independent, effective judicial systems), will have no access to medication or medical services. The exception again is where there is a threat to public health and/or safety.

The legal provisions dealing with designated countries will likely only come into effect at the end of 2012.

On October 23, 2012, Canadian Doctors for Refugee Care issued a second report, documenting another round of troubling cases of denial of medical care and services, including to children with severe asthma, contagious rashes and malaria.

In January 2013, after the changes to the designated countries covered by the new IFHP came into effect, health practitioners spoke in the media of “a humanitarian issue, right here at home,” assessing that access to health care in Canada for refugees was now worse than in refugee camps.

Taking the government to court

On February 25, 2013, Canadian Doctors for Refugee Care and the Canadian Association of Refugee Lawyers took the government to Federal Court, arguing that the changes to the IFHP violate sections of the Charter of Rights and Freedoms and are unconstitutional.

“The cuts threaten the rights to life and security of the person in section 7 of the Charter (…) In legal language, the cuts are arbitrary and unjustified.”

“The cuts amount to cruel and unusual treatment, contrary to section 12 of the Charter.”

“Contrary to section 15 of the Charter, the cuts discriminate against refugees from certain countries.”

“The cuts are inconsistent with Canada's international legal obligations.” (the Convention on the Rights of the Child and the Convention Relating the Status of Refugees)

A backgrounder on the legal challenge is available on the Canadian Association of Refugee Lawyers’ website.

Reacting to the legal challenge, Minister of Immigration and Citizenship, Jason Kenney, further dismissed the doctors and lawyers, reportedly saying that their claims were “totally ridiculous,” and branding them as “militant leftists.” He is reported to have said that “it’s just part of an ongoing ideological campaign.”

Protests continue

A year after the initial protests against the changes to refugee healthcare, Canadian Doctors for Refugee Care organized a second National Day of Action on June 17, 2013, with protests in twenty cities across the country.

Victory in the courts

On July 4, 2014, the Federal Court of Canada rendered its decision on the constitutional challenge. The Court struck down the changes to the IFHP, finding that the cuts constituted “cruel and unusual treatment,” contrary to section 12 of the Canadian Charter of Rights and Freedoms.

In unusually strong terms, the Court said that the Canadian government had intentionally targeted vulnerable people in order to achieve cost savings. As a result, “the 2012 modifications to the Interim Federal Health Program potentially jeopardize the health, the safety and indeed the very lives, [especially] of innocent and vulnerable children, in a manner that shocks the conscience and outrages our standards of decency.”

Not only did the cuts to the IFHP constitute cruel and unusual treatment, but the Court also held that they violated equality rights based on national origin

The Federal Court of Canada held that the 2012 OICs were unconstitutional and amounted to cruel and unusual treatment under the Charter, describing the impact of these changes in stark terms:

The effect of these changes is to deny funding for life-saving medications such as insulin and cardiac drugs to impoverished refugee claimants from war-torn countries such as Afghanistan and Iraq.

The effect of these changes is to deny funding for basic pre-natal, obstetrical and paediatric care to women and children seeking the protection of Canada from “Designated Countries of Origin” such as Mexico and Hungary.

The effect of these changes is to deny funding for any medical care whatsoever to individuals seeking refuge in Canada who are only entitled to a Pre-removal Risk Assessment, even if they suffer from a health condition that poses a risk to the public health and safety of Canadians.1

(For more about the impacts of the reforms to the IFHP, see our Nov. 2014 case study.)

Relevant Dates:

1957: The federal government begins to fund the Interim Federal Health Program (IFHP) services to provide temporary health-care coverage to refugees and people claiming refugee status.

September 2011: Civil servants who have been asked to cut the IFHP argue with their political bosses that government-assisted refugees and privately sponsored refugees should continue to receive health care services.

March 2012: The cuts to the IFHP are secretly introduced in the Budget tabled by the federal government in March.

April 25, 2012: The federal government announces plans to drastically cut back the IFHP.

May 11, 2012: More than 80 physicians, from a wide variety of specialties, descend on the office of Conservative Minister Joe Oliver to protest the changes.

May 17, 2012: The Toronto Board of Health sets out concerns about the cuts in a memorandum.

May 18, 2012: Prominent Canadian healthcare groups write to Citizenship and Immigration Minister Jason Kenney to protest the cuts. The groups include the Canadian Association of Optometrists, the Canadian Medical Association, the Canadian Nurses Association, the Canadian Association of Social Workers, the Canadian Dental Association, the Canadian Pharmacists Association, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada.

May 28, 2012: The Wellesley Institute issues a health equity impact assessment, condemning the cuts and alerting the public to the health care dangers that they will pose.

June 18, 2012: A National Day of Action to protect refugee health care services is called, with more than 2,000 health care workers coming together. Amnesty International issues a statement condemning the cuts on the same day.

June 28, 2012: The Canadian Civil Liberties Association writes a letter to Minister Jason Kenney to express deep concerns regarding the cuts and announce their support to the National Day of Action.

June 29, 2012: The government agrees to make minor changes to the new IFHP for the specific group of Government-Assisted Refugees.

September 27, 2012: A new group, Canadian Doctors for Refugee Care, issues an interim report on the negative impact of the cuts on medical care, public safety and public health. The government responds by accusing the doctors of being “activists” who are making “unsubstantiated claims” that “cannot be verified or disproved.”

October 23, 2012: Canadian Doctors for Refugee Care issues a second report on the impact of the cuts on vulnerable patients who need medical care.

July 4, 2014: Federal Court strikes down the changes to the IFHP that reduced access to health care, finding that the cuts constituted “cruel and unusual treatment,” contrary to section 12 of the Canadian Charter of Rights and Freedoms. The court also holds that an unlawful distinction between refugee claimants from Designated Country-of-Origin (DCO) countries and those from non-DCO countries has been created.

Role or Position

When the federal government cut most health services for refugees in April 2012, doctors across the country organized demonstrations, press conferences and public events in protest. Following an overwhelming response from the medical community and public at large, several physicians came together to launch Canadian Doctors for Refugee Care.

Implications and Consequences

Democracy: The accusation issued by Jason Kenney’s office, namely that the medical doctors – including some of Canada’s leading practitioners of community and family medicine – are lying, is unacceptable and irresponsible. It reinforces the perception that the government is seeking to instill to the Canadian public: that activists are disreputable and worthy of attack by the government.

Democracy: The other accusation brought forward by Minister Kenney, namely that the doctors and lawyers who launched the legal challenge in early 2013 have no serious ground to lay these claims and are themselves or connected to “militant leftists,” perpetuates a false divide of those who are “with” or “against” the government and dismisses any challenges to public policy as instruments of partisan politics.

Free Speech: The accusations are clearly designed to intimidate these professionals and to create a chilling effect on them and others who seek to speak out on policy-relevant issues of general concern.

Equality: Refugees and refugee claimants are among the most vulnerable people in Canada. They bear the brunt of the cuts to the IFHP and are disproportionately affected by decisions that reduce access to health care, especially in their first year in Canada when they are most vulnerable. This has a direct impact on their lives and on their security, in contravention of section 7, section 12 and section 15 of the Canadian Charter of Rights and Freedoms.

Equality: Professional and independent reports have demonstrated that women, children are disproportionately affected by the cuts. This is a violation not only of section 15 of the Canadian Charter of Rights and freedoms, but also of Canada’s international obligations under human rights treaties to eliminate discrimination against women and children. The impact on people with disabilities is a violation of the Convention on the Rights of People with Disabilities, which Canada has ratified. The cuts are also inconsistent with the Convention on the Rights of the Child and the Convention Relating the Status of Refugees.

Transparency: Cuts to the IFHP were buried in the federal budget, with no opportunity to consult with the stakeholders and health care providers who have massively and virtually unanimously opposed the cuts. The government’s use of omnibus budget bills and lack of transparency in undertaking cuts has been particularly decried by Parliamentary Budget Officer Kevin Page, who has faced considerable hurdles in obtaining information on the impact of budget cuts.